Intentional Replantation: A Case Report

Intentional Replantation of Single-Rooted and Multi-Rooted Teeth: A Systematic Review

The technique of intentional replantation can provide a second chance to save teeth that would be destined for extraction. Therefore, the present systematic review aimed primarily to estimate tooth survival after intentional replantation and secondarily to compare treatment outcomes in single-rooted and multi-rooted teeth. The study protocol was developed before the analysis according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Articles were electronically searched in PubMed/MEDLINE, the COCHRANE library and Google Scholar by two independent reviewers, and those that met the eligibility criteria were included. A statistical analysis using the chi-square test with a p-value of <0.05 was performed on the reported outcomes of intentional replantation. A total of 44 single-rooted replanted teeth with five failures (11.36%) and 42 multi-rooted replanted teeth with six failures (14.28%) were reported in the literature, corresponding to a survival rate of 88.64% and 85.57%, respectively. The overall survival rate for the replantation procedure was 86.7%, indicating that intentional replantation can be considered a safe therapeutic choice, with no statistically significant difference between the survival rates of single-rooted and multi-rooted replanted teeth.

A novel antibacterial resin-based root canal sealer modified by Dimethylaminododecyl Methacrylate

Persistent apical periodontitis, mainly caused by microorganisms infections, represents a critical challenge for endodontists. Dimethylaminododecyl methacrylate (DMADDM) is a well-studied and potent antibacterial agent used in various studies described in the literature. The aim of this study is to develop a novel antibacterial root canal sealer by incorporating DMADDM into EndoREZ and investigate the properties of the resulting material. Different mass fractions (0, 1.25%, 2.5%, and 5%) of DMADDM were incorporated into EndoREZ and the cytotoxicity, apical sealing ability and solubility of the resulting material were evaluated. Furthermore, a direct contact test, determination of colony-forming units, a crystal violet assay, scanning electronic microscopy and live/dead bacteria staining were performed to evaluate the antibacterial effect of the sealer to multispecies bacteria (Enterococcus faecalis, Streptococcus gordonii, Actinomyces naeslundii, and Lactobacillus acidophilus), in planktonic cells or biofilms. Fluorescence in situ hybridization and quantitative real-time polymerase chain reaction were carried out to assess the composition of the multispecies biofilms. No difference on the cytotoxicity, apical sealing ability and solubility between sealers containing DMADDM (1.25%, 2.5%) and EndoREZ (0%) could be determined. However, when the mass fraction of DMADDM increased to 5%, significantly different properties were found compared to the 0% (p < 0.05) group. Moreover, incorporating DMADDM into the sealer could greatly improve the antibacterial properties of EndoREZ. In addition, the composition ratio of E. faecalis could be decreased in multispecies microecology in sealers containing DMADDM. Therefore, a EndoREZ sealer material containing DMADDM could be considered useful in clinical applications for preventing and treating persistent apical periodontitis.

Autophagy preserves the osteogenic ability of periodontal ligament stem cells under high glucose conditions in rats

OBJECTIVE

To investigate how a high glucose environment influences the osteogenic ability of periodontal ligament stem cells (PDLSCs) and the function of autophagy in this process, we explored whether the osteogenic ability of PDLSCs could be protected by autophagy.

DESIGN

PDLSC proliferation and osteogenesis were evaluated by CCK-8 and western blotting under gradient glucose conditions. The Autophagy RT² Profiler PCR Array was used to screen autophagy-related mRNA expression during PDLSC osteoblastic differentiation on 5.5 mM + osteogenic induction (OI) medium or 25 mM + OI medium on day 3. Autophagy was regulated by an inducer (rapamycin) and inhibitor (bafilomycin) to investigate its protective effects on PDLSCs. A periodontal trauma model was established in diabetic rats to verify the effects of enhanced autophagy activity on PDLSCs.

RESULTS

A high glucose concentration (25 mM) impeded PDLSC proliferation on day 1, and compared with the control condition, high glucose also decreased the osteogenic ability of PDLSCs. The Autophagy RT² Profiler PCR Array showed obvious fluctuations in many autophagy-related genes, such as ULK1 (9.27), MTOR (3.15), MAP1LC3B (4.22), GABARAPL1 (7.09), ATG10 (6.5), AMPK14 (4.47), WIPI1 (3.29), and IGF1 (24.65). Compared with the control condition, an autophagy inducer or inhibitor markedly impaired or enhanced osteogenic differentiation in cells. The diabetic rat periodontal trauma model demonstrated that periodontium tissue partly recovered in the autophagy-enhanced cell injection diabetic rat group.

CONCLUSIONS

High glucose inhibited the activity of PDLSCs, and regulating autophagy protected cell function. Upregulating autophagy partially reversed the adverse effect of high glucose conditions on PDLSCs.

Periodontal tissue repair after sealing of the gap in vertical root fracture

The aim of this study was to determine whether sealing of fracture gap using adhesive resin through the root canal can prevent inflammation of periodontal tissue, and resealing the incompletely sealed fracture gap from outside can resolve such inflammation in experimentally created vertical root fractures. Vertical root fractures were created in incisor of beagles. In the experimental group, the fracture gap was sealed through the root canal with adhesive resin. After 5 weeks, sites with the clinical attachment level ≥4 mm were further divided randomly into the poor-replanting group and the poor-untreated group. In the poor-replanting group, the tooth was extracted and replanted after resealing the fracture gap with adhesive resin from the outer surface. Sites with clinical attachment level ≤3 mm after 5 weeks were considered as the satisfactory group. The poor-untreated group and the satisfactory group were subjected to no further treatment. The clinical attachment level was evaluated at baseline and after 2, 5, and 9 weeks. After 9 weeks, histological measurements were made to determine the length of the epithelial downgrowth and the area of alveolar bone resorption. The clinical attachment level and the area of bone resorption were significantly smaller in the poor-replanting group and the satisfactory group than in the poor-untreated group (p < 0.05). The results indicate the possibility that periodontal inflammation along the fracture line can be prevented and improved if the fracture gap is sealed.

The Use of Intentional Replantation to Repair an External Cervical Resorptive Lesion Not Amenable to Conventional Surgical Repair

Intentional replantation consists of purposefully extracting a tooth, correcting the defect and replanting it into its original socket. This case report describes how this technique was used to successfully restore an external cervical resorptive (ECR) lesion. A 22-year-old man was diagnosed with ECR of the mandibular right canine following clinical and radiographic examination. CBCT showed the lesion had been initiated distally and extended circumferentially around the root canal. The nature of the resorptive lesion meant that it was inaccessible to repair conventionally in a predictable manner. This report describes how intentional replantation was used to access and restore the lesion with minimal patient cooperation and postoperative discomfort. At an 18-month recall the tooth was clinically sound with no radiographic evidence of inflammatory or replacement root resorption. Intentional replantation should be considered a viable treatment option when ECR is inaccessible and cannot be restored using conventional techniques.

The usefulness of three-dimensional imaging for prognostication in cases of intentional tooth replantation

This paper describes the utility of three-dimensional (3D) images obtained with cone beam computed tomography (CBCT) for prediction of successful clinical outcome in two cases of intentional tooth replantation (IR). IR was performed for teeth affected by vertical root fracture and root perforation with local application of blood clot and oxy-tetracycline antibiotic. High-resolution 3D images demonstrated no evidence of ankylosis, but did reveal the presence of alveolar bone regeneration, suggesting a good long-term prognosis. Our observations in these cases suggested that local application of the above two materials might help to induce the regeneration of lost periodontal tissues in IR.

Intentional replantation for the management of maxillary sinusitis

AIM

To present a case that emphasizes the importance of the use of intentional replantation as a technique to successfully treat a periapical lesion and an odontogenic maxillary sinusitis through the alveolus at the same time.

SUMMARY

This case report presents a patient with odontogenic maxillary sinusitis secondary to periapical disease of a maxillary molar that had previously received root canal treatment. The molar was extracted, with drainage and rinsing of the maxillary sinus. The apices were resected extra-orally, the retrograde cavities prepared with ultrasound and retrograde fillings of silver amalgam placed. The tooth was then replanted. After 2 years, the patient was asymptomatic, periapical radiography showed no evidence of root resorption and computed tomography scanning demonstrated the resolution of maxillary sinusitis.

KEY LEARNING POINTS

*When root canal treatment or periapical surgery cannot be undertaken or has failed, intentional replantation may be considered. *This alternative treatment may be predictable in certain cases.